A 7.8-year-old boy who was diagnosed with hypothyroidism by a dermatologist who was seeing him for eczema. His only other complaint was constipation. TSH was 858 mU/L, total T4 1.2 mg/dL (15.4 nmol/L), and bone age 3.5 years. He had been measured but not plotted on a growth chart at his primary care clinic, where his 3-year lack of growth was not appreciated. Note the classic physical appearance (A), the growth chart showing cessation of growth with subsequent catch-up following thyroid hormone replacement (B), and the testicular enlargement in the face of low testosterone levels (testosterone = <10 ng/dL or <0.4 nmol/L) and absence of pubic hair (C). (Photos reproduced with permission from Antoinette Moran.) Source: Disorders of the Thyroid Gland, Pediatric Endocrinology and Inborn Errors of Metabolism, 2e Citation: Sarafoglou K, Hoffmann GF, Roth KS. Pediatric Endocrinology and Inborn Errors of Metabolism, 2e; 2017 Available at: https://accesspediatrics.mhmedical.com/DownloadImage.aspx?image=/data/books/2042/saraped2_ch27_f005c.png&sec=154113287&BookID=2042&ChapterSecID=154113162&imagename= Accessed: November 05, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved